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General NPI Number Information
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NPI Number | 1033459870
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Entity Type | Organization
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Legal Business Name | RYANJASON INC.
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 518 MONROE TPKE #2
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City | MONROE
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State | CT
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Zip | 06468-2358
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Country | US
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Telephone | 203-261-5777
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Fax | 203-261-5770
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Provider Business Mailing Address
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Address Line | 518 MONROE TPKE #2
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City | MONROE
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State | CT
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Zip | 06468-2358
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Country | US
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Telephone | 203-261-5777
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Fax | 203-261-5770
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA KAREN RANDALL
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Credential |
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Telephone | 203-261-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCA.0000684
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License Number State | CT
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